chapter  19
Health Plan Issues
Pages 14

See Title 42 U.S.C. 300gg-91(a)(2) for full details of health plan medical care costs.

A health plan, as dened in the Public Health Service (PHS) Act, includes any combination of the following:

• A group health plan (as dened in Section 2791[a] of the PHS Act), if the plan • Has 50 or more participants (as dened in Section 3[7] of

the Employee Retirement Income Security Act [ERISA] of 1974)

• Is administered by an entity other than the employer who established and maintains the plan

• A health insurance issuer (as dened in Section 2791[b] of the PHS Act)

• A health maintenance organization (as dened in Section 2791[b] of the PHS Act)

• Part A or B of the Medicare program under Title XVIII • e Medicaid program under Title XIX • A Medicare supplemental policy (as dened in Section

1882[g][1]) • A long-term care policy, including a nursing home xed indem-

nity policy (unless the secretary of the Department of Health and Human Services [HHS] determines that such a policy does not provide suciently comprehensive coverage of a benet so that the policy should be treated as a health plan)

• An employee welfare benet plan or any other arrangement that is established or maintained for the purpose of oering or providing health benets to the employees of two or more employers

• e health care program for active military personnel under Title 10 U.S.C.